Wu: And that’s been clear for some time now—that the outbreak has been ballooning, and that resources are scarce. Should we have declared a public-health emergency sooner? Would that have helped?

Gonsalves: A declaration of a public-health emergency gives us some ability to do certain things that ordinarily we can’t. But what’s instructive to me is that we’ve had a public-health emergency for COVID. And two COVID czars! And we were the leaders in COVID deaths per capita among the G7, and now we’re the leaders in absolute numbers of monkeypox cases. So appointing leaders and declaring declarations is one thing.

But when you have leaders saying this has been an aggressive response since day one, and this is where we are? That doesn’t make you feel confident in our nation’s response to this new, emerging outbreak. It would be much more useful to say, we got out of the gate slow, but we are now bringing in all relevant federal actors. We are talking with local and state health departments. We are talking with community-based organizations. And we’re going to use all resources of government in a strategic operational campaign to deal with this. Right now, I’m still not sure what their plan is. We’re going to cut the vaccine doses into five pieces? We need research to evaluate that, or think about ACAM2000 [an older smallpox vaccine with more side effects] as a fallback.

And there’s still no real articulation of how we’re going to continue to ramp up diagnoses so that we can figure out where lingering cases are. Commercial vendors are now testing, but we’re still mostly in the passive surveillance [phase], where people are coming to sexual-health clinics, their primary-care physicians. How much active testing is going on in the community, working with organizations funded by the Ryan White HIV/AIDS program [which provides resources to low-income people living with HIV], for instance? To get out into gay bars, sex clubs, gay parties, and offering people who might have suspicious lesions or pimples or bumps the privacy of a mobile-health van to get tested, or a referral for testing at a nearby location? Also, you have to be in [isolation] for 21 days with this infection. Many people can’t afford to do that. And some of the men who are catching this are either underinsured or uninsured. And there are still lingering problems with access to [the antiviral] Tpoxx.